N.C. nursing board investigating midwife at Cary birthing center

By John Murawski, The News & Observer

Wednesday

Mar 28, 2018 at 9:51 AM

Cary, N.C. — The state nursing board has launched an investigation of a nurse midwife who delivers newborns at Baby+Co., the natural birthing center in Cary where three newborns have died in the past six months.

The board's investigation was prompted by a complaint filed Friday, but the complaint does not appear to be connected to the recent newborn deaths or to safety issues at the facility. According to N.C. Board of Nursing spokesman David Kalbacker, the complaint pertains to the midwife's patient care in 2017, and will remain confidential under the board's policy. The matter would become public only if investigators find evidence of improper professional conduct by the midwife.

Four newborns have died at the Baby+Co. facility since the Cary site opened in the fall of 2014, a sequence of tragic incidents that caused the center to temporarily halt baby deliveries. The company has halted deliveries in Cary twice before in the past seven months to review the earlier deaths, the company said Monday, each time sending pregnant women to deliver at the nearby WakeMed Cary Hospital, Baby+Co.'s business partner.

In light of the most recent death, Baby+Co. is now reviewing all four infant deaths with WakeMed, with the Commission on the Accreditation of Birth Centers and with an additional outside reviewer who was not involved in the previous two internal reviews. Baby+Co. operates six birthing centers in three states, and has experienced just one newborn death at its other five centers over the past four years.

Still, as in the earlier internal reviews, Baby+Co. expects to resume delivering babies.

"We have every expectation that we will be able to resume offering births in the very near future in Cary," the company said by email Monday. "We do not reopen until we are fully confident in the safety of our center."

Baby+Co.'s clients are currently delivering in WakeMed under the guidance of the natural birthing center's nurse midwives, who have practicing privileges at the hospital. Of the Cary facility's 31 employees, 11 are nurse midwives.

The company said it has not received information about Friday's complaint from the N.C. Board of Nursing.

"We believe in providing outstanding care and are happy to support the state board should they move forward with an investigation," Baby+Co. said by email. "With respect to everyone involved, it is important to understand that this complaint has not been validated."

Low infant mortality rates

North Carolina has just 342 certified nurse midwives listed on the N.C. Board of Nursing's web site. Since 2014, there have been 14 complaints filed against nurse midwives in North Carolina. So far, only one complaint has led to a suspended license. Two investigations, including the complaint filed Friday, remain open, said board spokesman Kalbacker. In the other cases, there was insufficient evidence for disciplinary action. None of the complaints, until the one filed Friday, was connected to Baby+Co., Kalbacker said.

Birth centers generally have low infant mortality rates because they only accept low-risk women for deliveries, said Rebecca Bagley, a professor and director of East Carolina University's Midwifery Education Program, the state's only program for training nurse midwives. A 2018 analysis by the Journal of Midwifery & Women's Health found that 30 percent of non-hospital births in the country took place in birthing centers in 2014, and death rates for low-risk women were comparable to hospitals.

At any time a woman in labor can request to be transferred from Baby+Co. to WakeMed Cary, less than a half-mile away, to finish her delivery if she is uncomfortable at the birth center or decides the hospital is the safer option, the company said. In those instances the woman would be taken by private car.

If a delivery goes awry, a Baby+Co. nurse midwife calls 911 for an ambulance to take the mother and baby to WakeMed Cary. Since 2015, Baby+Co has called Wake County EMS for emergency transport 32 times, half of the calls taking place in 2016, according to an EMS spokesman.

So far this year, Baby+Co has called 911 three times for ambulance transports before suspending deliveries and sending all moms to deliver at the hospital in early March. The Cary facility has delivered more than 1,200 babies since opening in October 2014.

"We know that diversion is not ideal for clients who were otherwise planning a birth center birth," the company's email statement said, "and not all health systems enact diversion as a tool when there are multiple incidents, but we hold ourselves to an extremely high standard of care and feel this is the best next step to take to ensure optimal safety for our patients."

Midwifery requirements

There are seven natural birth centers in North Carolina. It is one of nine states in the country that does not regulate natural birth centers or require a state license or permit to operate. They can, however, receive national accreditation from the Commission on the Accreditation of Birth Centers and be periodically reviewed. Midwives, however, must be licensed.

At Baby+Co., deliveries are directly overseen by nurse midwives, which are the only type of midwife allowed to practice in North Carolina. Nurse midwives have the most stringent educational standards in the midwifery field. In North Carolina, a nurse midwife must be licensed as a registered nurse and hold a master's degree in nurse midwifery. Bagley estimated that a recent graduate's starting salary averages between $75,000 and $95,000 a year, a reflection of the educational requirements and qualifications for the nurse midwifery profession.

Baby+Co. offers women a spa-like setting where they can deliver in a private room with water tubs and family and friends present. A key difference between a hospital birth and a birth center delivery is that at a hospital maternity ward women are connected to continuous monitors to track fetal heart rate and the duration of a woman's contractions. At a birth center, midwives use a handheld device to periodically monitor the heart of the fetus, typically checking once an hour early on and every 15 minutes during the actual delivery. The American College of Obstetricians and Gynecologists has issued guidance saying that there is no benefit to using continuous monitoring for a low-risk pregnancy.

Bagley said some women prefer birthing centers because they want less medical intervention and no drugs during childbirth if those treatments are not necessary, and the midwifery birth model results in fewer Caesarian births. She said that a nurse midwife is trained to detect irregularities and potential problems during delivery that would require the involvement of doctors.

The recent newborn deaths could have multiple causes, she said, and some newborn deaths can never be explained, but each must be thoroughly investigated.

"When I hear this I am just met with profound sadness," Bagley said of Baby+Co.'s baby deaths. "We need to know what happened that has caused this many babies to die in one location in such a short period of time."

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